Alabama

Alabama TB cases are on the rise with no clear cause for the jump

There were 161 tuberculosis cases, many discovered with tests like this one from a Bayou La Batre file photo, in Alabama last year. (Press-Register/Victor Calhoun)

BIRMINGHAM, Alabama -- The number of tuberculosis cases in Alabama jumped last year after a decade of fairly steady decline, and experts said the nature of cases is changing, as well.

Alabama saw 161 TB cases last year, a 10 percent increase from 2010. A confirmed case in Tuscaloosa two weeks ago was the 83rd case of the potentially deadly disease in Alabama this year.

There’s no clear cause for the increase, said Pam Barrett, director of the tuberculosis program with the Alabama Department of Public Health. But officials are watching the numbers this year closely, she said, and there’s no doubt about what it will take to minimize new outbreaks: boots on the ground.

“The field staff is the key to the decline of TB throughout the state,” Barrett said.

Another thing of which health officials are certain is that they’re seeing a different sort of victim than in years past. Historically, those most at risk have been people who grew up a generation ago, when TB was a much bigger problem. Infection rates have plummeted because of advances in treatment and management.

Today, however, they’re seeing more immigrant victims and more people with other medical problems.

“The cases are different than the historical TB patients,” Barrett said. “We have a lot of foreign-born TB. We have people with HIV; they’re immuno-compromised.”

That’s consistent with national trends. According to the Centers for Disease Control and Prevention in Atlanta, 60 percent of all cases nationally last year were among foreign-born residents. The highest rate of infection nationally is among people of Asian descent, who face a rate of infection 22 times higher than the rate for whites, according to CDC data.

Nationally, 547 people died from TB in 2009, in 11,537 cases. That gives the disease a mortality rate of just under 5 percent.

TB is caused by a bacterium called Mycobacterium tuberculosis. Most commonly, the CDC said, it attacks the lungs, resulting in a persistent productive cough that may bring up blood, weight loss, fever, night sweats and fatigue.

About 10 percent of people will become infected with TB at some point in their lives, but most will never know it.

“If you have the TB germ, as long as your immune system is healthy, you may never develop active TB,” Barrett said.

The bacteria are airborne, making those who work in an enclosed space with an infected person more likely to become infected themselves.

The rate of infection, and the numbers infected, have plummeted in the United States and Alabama over the past generation. In the 1990s, Alabama saw more than 400 cases a year, about three times the current numbers. As recently as 2003, Alabama had a confirmed case rate of 5.5 in every 100,000 population.

In 2010, before the 2011 jump, the state recorded a record low 146 cases for a confirmed case rate of 3.1 per 100,000.

Rates have come down so dramatically in Alabama and the nation because public health officials have learned to quickly identify cases, and to begin procedures to limit exposure of others even before cases are confirmed, Barrett said.

The Alabama Department of Public Health typically runs tests on patients suspected of having TB no later than one day after the case is reported, and they administer drugs to control it even before getting back test results.

A state-run team also interviews a patient’s family, friends and co-workers to identify those at risk, and tests everyone who may have been exposed.

“We’re not just sitting around,” Barrett said. “We’re gathering information about family, work, things like that. And usually by the second or third day we have our laboratory confirmation. We like to jump right on it.”

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